Assisted reproduction associated with higher risks in twin pregnancies

By Paula Moyer

NEW YORK (Reuters Health) – A twin pregnancy is at higher risk of several complications if the pregnancy is the result of assisted reproduction rather than spontaneous conception, according to Dr. Barbara Luke, speaking in New Orleans at the 22nd annual meeting of the Society for Maternal-Fetal Medicine.

"When caring for pregnant patients who have used assisted reproduction and are carrying twins, physicians need to be aware of the factors that improve fetal growth and implement them even sooner than in a spontaneously conceived twin pregnancy, particularly if the mother has undergone fetal reduction," Dr. Luke told Reuters Health. "We need to look for modifiable risks such as work, physical activity, and nutrition and improve the factors we have control over."

Dr. Luke is an epidemiologist and professor of obstetrics-gynecology at the University of Michigan Medical School in Ann Arbor. In a multicenter study, she and her colleagues compared 415 assisted-conception and 2523 spontaneously conceived twin pregnancies. They controlled for several potentially compounding factors, including maternal race, age, insurance status, height, weight before pregnancy, smoking status, status of placental membranes, fetal reduction, and fetal gender.

The investigators found that the assisted-conception pregnancies were shorter than those spontaneously conceived by a mean of 5.1 days. The adjusted odds ratio (AOR) of delivery before 36 weeks was 1.35, with an AOR of 1.50 for delivery before 32 weeks. Assisted-conception twins' mean birth weight averaged 110 g less than those spontaneously conceived. The assisted-conception twins had an AOR of 1.40 for a birth weight of less than 2500 g, while the two groups had an equivalent risk of birth weight below 1500 g.

Mothers of assisted-conception pregnancies also had an AOR of 8.70 for cerclage and 1.45 for preterm labor. The two groups had equivalent risks for pre-eclampsia and preterm rupture of membranes.

A history of fetal reduction added to the assisted-conception pregnancies' risks for lower birth weights and preterm birth. "The higher the starting number of pregnancies, also, the higher the risk of these complications," Dr. Luke told Reuters Health.

Mothers with assisted-conception pregnancies were more likely to be nulliparous and to have hypothyroidism; 33% of the assisted-conception mothers were at least 35 years old, in contrast to 11% of those with spontaneous pregnancies. "It's not so much the assisted reproduction, it's the associated risks that increase the magnitude for adverse outcomes," Dr. Luke told Reuters Health.

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